Candidal vulvovaginitis is a common condition for productive-age women and one of the most frequent reasons for women to seek a medical advice. During last 10 years the number of women affected by candidal vulvovaginitis almost doubled and it is 30-45% among the infection diseases of vulva and vagina.
Candidal vaginitis is caused by yeastlike fungi Candida. At present more than 170 species of yeastlike fungi is described. C. albicans is the most frequent causative agent of a candidal vaginitis in 85-90% of women. C. glabrata (5-10%), C. tropicalis (3-5%), C. parapsilosis (3-5%) and C. krusei (1-3%) are also clinically significant among other species of Candida. 
Significant increasing of candidal vulvovaginitis is caused by a number of predisposing factors, such as long and uncontrolled using of antibiotics, corticosteroids, cytostatics, oral contraceptives, radiation therapy, serious infectious disease, endocrine disorder, immunodeficiency state, etc. At prescription of broad spectrum antibiotics leaves out of account that they suppress not only pathogenic bacteria, but also mucous vaginas saprophytes: lactobacilli and bifidobacteria. As a result vaginal pH raises (towards to alkaline range), and disturbance of self-cleaning processes occurs. Besides, Candida is able to use some antibiotics as nutrient substrates. Thus favorable conditions for active overgrowth of Candida arises in female genital organs.
Changing the pH value of vaginal secretion is also caused by hormonal drug products. Significant growth of the number of candidal vaginitis cases mainly attributes to administration of oral contraceptives. It is reviled that administration of hormonal drug products led to growth of the glycogen concentration in vaginal epithelium cells, the epithelium becomes loosened, pH value moves to alkaline range and the nonspecific resistance decreases. In 20% of woman who administrate the oral contraceptive the tolerance to glucose is changed promoting the candidal infection changes.
Pregnancy also promotes the development of candidosis due to hormonal changes. Slump (by 60%) in rate of positive results of the fungi isolation during postnatal period indicates the connection of candidal vulvovaginitis with pregnancy.
Wearing of tight synthetic underclothes creating the microclimate with increased temperature and humidity promotes development of candidosis vulvovaginitis.
Candida can be isolated from a vagina of the almost healthy women in the absence of clinical signs of candidosis vulvovaginitis (carrier). These fungi become pathogenic on certain conditions under the influence of exogenous and/or endogenous factors. In the presence of essential risk factors, for example during pregnancy, any detection of Candida fungi in a vagina indicates candidal vulvovaginitis but not a carriage. It is confirmed by results of the following research: only 2% of pregnant women with C. albicans vaginal seeding displayed absence of any pathological changes.
There is the data that gastrointestinal tract is a permanent fungi reservoir and a source for reinfection of vagina when it is recurrent candidal vulvovaginitis. In the cases of determination of fungi in vagina, they are almost found in feces, and vaginal and intestinal strains are identical at that. Usually candidosis have endogenous character as a wake of dysbiosis, metabolic disturbance and immune system dysfunction.
Considering that C. albicans strains isolated from the patients with candidal vulvovaginitis and carrier essentially don't differ, it is possible to draw a conclusion about leading role of immune system in development of candidal vulvovaginitis.
At present the following antimycotic agents for treatment of candidal vulvovaginitis are known. These are imidazoles: clotrimazole, miconazole, oxiconazole, bifonazole, econazole, omoconazole, fenticonazole, isoconazole, terconazole, tioconazole, ketoconazole. Ciclopirox. Allylamines: naftifine. Polyene antibiotics: aniphotericin B, nystatin, levorin and natamycin. Triazoles: fluconazole, itraconazole and other fungicidal and fungistatic preparations.
All these antimycotics are included in the formulation of the pharmaceuticals forms for local and systemic treatment of candidal vaginitis and vulvovaginitis and also in the formulation of creams, emulsions and gels for applying to skin and mucous membrane where mycotic lesion places.
Prebiotics that are indigestible elements of foodstuffs which stimulate growth and development of bacteria dominant species in large intestine microbiocenosis in human body are known. It is lactobacilli and bifidobacteria which use prebiotics as a source of carbohydrates (see U.S. Pat. No. 6,455,068, issued Sep. 24, 2002, incorporated herein by reference in its entirety).
As to chemistry prebiotics are short chain oligo- and disaccharides (fructooligosacharides, galactooligosacharides, maltooligosaccharides, lactulose etc.) that are included into many foodstuffs. In the human body oligosaccharides don't split in the upper gastrointestinal tract and reach a large intestine without changing. Here they are utilized by bifidobacteria and lactobacilli, that is why they are named as “bifidogenic factor”.
Stimulation of indogenous intestine microflora growth is connected to inhibition of pathogenic microflora growth, barrier function increase of intestinal mucous membrane and resistance to colonization of the intestine by an extraneous microflora including fungi and yeast.
Normal vaginal microflora contents gram-positive and gram-negative aerobic and anaerobic microorganisms.
Lactobacilli are vaginal microflora dominant.
Optimal conditions of their cultivation are anaerobic conditions when pH value is low (5.5-6.5).
Vaginal microflora of healthy woman completely protects vagina against superinfection by pathogenic bacteria and fungi, supporting low pH value.
By results of microbiological examination of healthy women in reproductive age lactobacilli are determined in vaginal microflora in 97.8% of cases (among them Lactobacillus acidophilus in 86.7%), bifidobacteria in 62.2% (among them Bifidobacterium adolescentis in 20.0%). According to various data lactobacilli present in vaginal contents in 70-100% of cases.
Decrease of vaginal lactobacilli titer is a result of reducing competition for nutrient substrates due to increase of pH values under circumstances of intense growth and reproduction of opportunistic microflora, which under normal conditions is suppressed by lactic acid producers.
Protective properties of the normal vagina microflora against exogenous pathogens are fulfilled in different ways: by antagonistic activity, competition for substrates, ability to produce lysozyme, adhesive properties, but undoubtedly its main mechanisms are lactic acid and hydrogen peroxide producing.
Thus, the main therapeutic challenge in candidal vulvovaginitis treatment is a restoration of normal vaginal microflora, when physiological mechanisms of the colonization of mucous membrane by saprophytes promote growth suppression of potential pathogens which are Candida as usual.
Antimycotics inhibit the growth of fungi and promote the elimination of causative agent, but don't create conditions for restoring normal vaginal microflora that provokes recurrent vaginal candidosis by permanent physiological Candida superinfection. Use of prebiotic lactulose in the form of vaginal tampons (see U.S. Pat. No. 3,860,707, issued Jan. 14, 1975, incorporated herein by reference in its entirety) was suggested to restore normal microflora in the treatment of candidal vulvovaginitis.
However a disadvantage of the invention is a usage of lactulose in the form of syrup which has more than 40% of impurities of other saccharides (lactose, fructose, and galactose) which stimulate growth of opportunistic and pathogenic microorganisms.
Suggested tampon form impregnated with a liquid lactulose syrup is inconvenient in use because during application part of lactulose is squeezed from a tissue and spoils the underclothes. Besides usage of tampon impregnated with lactulose syrup, is dangerous, because it can cause mass reproduction and lysis of pathogenic microorganisms inside a tampon and absorption of bacterial endo- and ectotoxins by vaginal mucous membrane.
Tampons impregnated with lactulose syrup does not contain antiseptic components, therefore Candida elimination occurs slowly during normal vaginal flora restoration and competitive inhibition of fungi growth, considering a competition for nutritious substrates in the microbial association presented by bacilli, bacteria and fungi.
Abbreviations used in FIGS. 1-5: FOS—fructooligosaccharides (Raftiline HP, Orafti, Belgium), GOS—galactooligosaccharides (Oligomate 55, Yakut, Japan), XOS—Xilooligosaccharides (Xylooligo-95P, Suntory), MOS—maltooligosaccharides (Maltotetraose, Chemos GmbH, Germany), IMO—isomaltooligosaccharides (IMO, Chemos GmbH, Germany), Lactulose—(Sigma-Aldrich, USA).
Values of the relevant microflora Ig concentration by CFU/ml are plotted on the vertical axis in the FIGS. 1-7.